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  • Title: A clinicopathologic series of primary graft failure after Descemet's stripping and automated endothelial keratoplasty.
    Author: Oster SF, Ebrahimi KB, Eberhart CG, Schein OD, Stark WJ, Jun AS.
    Journal: Ophthalmology; 2009 Apr; 116(4):609-14. PubMed ID: 18962919.
    Abstract:
    PURPOSE: To characterize the clinical and histologic features of primary graft failure after Descemet's stripping and automated endothelial keratoplasty (DSAEK). DESIGN: Retrospective observational case series. PARTICIPANTS: Sixteen cases of DSAEK graft failure from 15 patients, all with detailed histologic examination of failed graft tissue. METHODS: Hematoxylin-eosin, periodic acid-Schiff staining, and light microscopy were used to examine the failed DSAEK graft tissue from all patients. MAIN OUTCOME MEASURES: Examination of specimens for corneal endothelial cell viability and host-donor interface characteristics. RESULTS: Clinical history revealed that 88% (14/16) of studied DSAEK grafts detached before failure, and pathologic examination found that 75% (12/16) of failed grafts had atrophic corneal endothelium. Examples of residual host Descemet's membrane in the graft site and improper donor trephination were also identified. CONCLUSIONS: Marked loss of the corneal endothelium is the prominent feature of primary DSAEK graft failure. Examples of surgical features, such as incomplete Descemet's stripping and residual full-thickness cornea with a DSAEK graft, are shown.
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